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Weekender 11/8/19

November 8, 2019 Weekender No Comments

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Weekly News Recap

  • A study finds that only 10% of discharged hospital patients look at their medical information online afterward.
  • CompuGroup Medical is rumored to be a bidder for Agfa’s health IT business.
  • The VA makes patient records available on Apple Health Records.
  • A federal court orders behavioral EHR vendor ZenCharts to pay rehab EHR vendor Kipu Systems $19.5 million for stealing its trade secrets.
  • University of Rochester Medical Center will pay $3 million to settle OCR charges involving loss of two unencrypted mobile devices.
  • Google announces that it will acquire Fitbit for $2.1 billion in cash.
  • CMS delays implementation of a requirement that hospitals publicly share their negotiated contract prices.
  • Allscripts announces Q3 results that beat Wall Street expectations on adjusted earnings, but fell short on revenue.
  • Wake Forest Baptist Medical Center will bring registration and billing back in-house two years into a seven-year agreement with NThrive, which will eliminate 839 jobs in central North Carolina as a result.

Best Reader Comments

If you listen to the [Allscripts earnings] call, it is pretty clear that the Wall Street folks don’t buy it. They made Rick say twice that there wouldn’t be any increase in R&D spending due to the Northwell agreement. (TheyDidn’tBuyIt)

Most of the article [a physician’s New York Times complaint that Epic’s screen messages aren’t empathetic] could be rephrased as “I find my HIM department annoying.” (Iam)

I don’t consider myself an old fogey. but “pop-ups would float into view as small islands of empathy?” Seriously? In a NYT piece? Millenials these days, am I right? (CynicalIguess)

Epic has “unintelligible medical notes?” Nope, Epic has no such thing. I don’t think it has achieved sentience yet (thankfully). Talk to your co-workers who wrote the notes. “Urgent, intimidating, and tinged with allegation?” She’s looking for comfort and empathy from a computer system? (AC)

Everything about this op-ed by this physician is what is wrong with this country at this point. How in the world do people get through their day-to-day lives if every word that crosses their screen is “offensive” to them? It’s absurd. There are plenty of things wrong with EMRs in today’s world, but guess what — colors and “word choices” are not one of them. Not everything is about offending you, it’s simply just a word that by definition means something whether it hurts your feelings or not. Get over yourself. (EMR Snowflakes)

Would Epic benefit from having a better UI and more clinicians actively involved in software and workflow design? Absolutely. But the idea that “deficiencies” is something that Epic dreamed up and foisted upon their users? Come on, Epic configuration is heavily controlled by your own organization. You want Epic to be nicer to you? Talk to administrative and operational leadership at your organization. I’m sure they could ask IT to write an alert to pop up once a week to say “Great job!!” which everyone would then complain about being distracting and adding clicks. (AnonZ)

The authors rail against profit-seeking entities. Very slippery slope. No margin, no mission. Physicians can certainly fulfill their sense of moral mission and alignment in volunteer work, free clinics or other worthy ventures. Those skills are needed everywhere. (FreeMarkets)

Facebook design is meant to maximize engagement so that they can deliver the most ads. Do you want to maximize engagement with your EHR or do you want to make eye contact with the patient? (Lookatme)

One example that we started at a previous organization is to make sure there is a hyperlink (or text in the alert) that shows with each BPA (pop-up alert) which links to the decision-making body that approved it. Typically, it has a colleague on the committee that they know and can email directly or ask them about it. This provides accountability to the alert committee as well as the operational leaders that may have come up with the “software solution to a peopleware problem.” (David Butler)


Watercooler Talk Tidbits

Actor Will Smith creates a clever and disarmingly funny video as he undergoes his first colonoscopy. He said, “They said you can’t get to 50 million followers on IG without showing your butt.” Afterward, he finds that he had a pre-cancerous polyp removed during the procedure. He urges, “There’s a certain amount of commitment and embarrassment involved with being healthy. You just gotta do it, man.” I don’t watch many movies and thus have only seen Smith in “Independence Day,” “Men in Black,” and “The Pursuit of Happyness,” so I have to say this is my favorite of his films.

The former Hewlett-Packard Enterprise worker who shut down Oregon’s Medicaid computer system in October 2016 in retaliation for being laid off is sentenced to a year of home detention, 500 hours of community service, and four years of probation.

Fedscoop notes that HHS has two people who claim to be its chief data officer – one within the CTO’s office, and the other being the CIO, who says he is acting in that role until he can hire HHS’s “first chief data officer.”

A Pennsylvania nursing home assistant is arrested for taking photos of deceased residents and sharing them with with friends and co-workers. Stephanie Thomas says she took the pictures because her former boyfriend “liked that kind of thing,” but friends to whom she texted photos said she has an “obsession with death” and police examination of her phone turned up pictures of dead animals.

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A woman takes an after-work photo of her twin sister, a labor and delivery nurse who had worked 53 hours in four days, and posts it on Facebook with description of what the nurse deals with in a typical work day. She took the picture as her sister broke down after a day in which she helped deliver a stillborn baby. The post has earned 225,000 likes, 23,000 comments, and 133,000 shares. Her sister’s post explained what was going on:

Have you guys ever really thought about what a labor and delivery nurse sees? They see great joy in smooth deliveries and healthy moms and babies. They see panic and anxiety when a new mom is scared. They see fear when a stat C-section is called. They see peace when the mom has support from her family, because not all new moms do. They see teenagers giving birth. They see an addicted mom give birth to a baby who is withdrawing. They see child protective services come. They see funeral homes come. Did you know that they have to make arrangements for the funeral home to come pick up the baby? I didn’t either.

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A 57-year-old nurse adopts a 27-year-old man after he is ruled ineligible for a heart transplant because he has no family to care for him. He was in and out of hospitals for weeks, often discharged to a men’s shelter because he had nowhere else to go. Piedmont Newnan Hospital (GA) gave PACU nurse Lori Wood its President’s Award for going above and beyond for patients. She had known Jonathan Pinkard for just two days before suggesting that she become his legal guardian. He hopes to return to his office clerk job next month.


In Case You Missed It


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Morning Headlines 11/8/19

November 7, 2019 Headlines No Comments

Most patients with access to electronic medical records not using it

Just one in 10 discharged patients go online to access their medical information, according to a study that looked at data from 2,410 hospitals over a two-year period.

American Well® Acquires Aligned Telehealth to Expand Behavioral Health Virtual Care

American Well acquires behavioral telehealth and telepsychiatry service provider Aligned Telehealth.

Elizabeth Holmes dodges questions about unpaid legal bills as charges fly over case documents

Lawyers for Elizabeth Holmes contend in a hearing that the FDA destroyed emails that are vital to her defense.

Michigan Health Information Network Shared Services integrates Great Lakes Health Connect

Michigan Health Information Network Shared Services and Great Lakes Health Connect will combine their HIE operations by the end of the year.

News 11/8/19

November 7, 2019 News No Comments

Top News

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Just one in 10 discharged patients go online to access their medical information, according to a study that looked at data from 2,410 hospitals over a two-year period.

The analysis also found that patients at non-profit hospitals are more likely to take advantage of access than their counterparts at for-profit organizations, as are patients at teaching hospitals.

The authors conclude that “policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the ‘digital divide’ that accompanies health care disparities.”


Reader Comments

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From Being There: “Re: HLTH conference. As a participant and attendee, I found this to be a first-rate event. Other than a couple of HHS speakers who seemed more intent on politics versus real healthcare, the rest were engaging, interesting, and first rate. I especially like the panel discussion format used in the tracks I attended. As an exhibitor, I was disappointed in the value provided for the cost incurred. Activity was low most of the time, including the happy hour which helped a bit, but not enough. My theory is that there is just too many good speakers and sessions which are running concurrently such that, if I didn’t have to be in the exhibit area, I would have been attending tracks and sessions instead. PS: the free Mimosas on Sunday morning were especially nice.”

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From Mandibular Process: “Re: HIMS. Why in the world would a company name themselves this?” I took “in the world” part of this question literally, assuming that a company that was started in 2014 would choose this name only if (a) it is clueless, or (b) it is brazenly hiding behind some other country’s less-litigious legal system. Not so. Even though the HIMS website does not list people or places (not uncommon with foreign companies trying to look domestic), I tracked them down to Arizona, where a postal race is probably unfolding to see whether our industry’s HIMSS or from the Viagra-selling website HIMS will land the first cease-and-desist letter.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Reuters reports that CompuGroup Medical is one of two top bidders for the health IT and integrated care parts of Agfa’s European healthcare business.

American Well acquires behavioral telehealth and telepsychiatry service provider Aligned Telehealth.

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Lawyers for Elizabeth Holmes contend in a hearing that the FDA destroyed emails that are vital to her defense. The former Theranos CEO and co-defendant Ramesh “Sunny” Balwani –a former Theranos executive and romantic partner of Holmes — face up to nine counts of wire fraud and two counts of conspiracy to commit wire fraud. The FDA has admitted to having only partial emails from the former director of its diagnostics regulatory division, which it blames on a faulty email storage system.


Sales

  • The Ohio State University Wexner Medical Center will implement Visage Imaging’s Visage 7 Enterprise Imaging Platform in all of its radiology departments, replacing its legacy PACS.
  • Boston Health Care for the Homeless will use an addiction treatment-focused EHR from Netsmart to help care for patients with opioid use disorder.
  • Prisma Health (SC) selects telehealth technology and services from MDLive.
  • Health and human service agency network Innovative Management Solutions (NY) will implement population health analytics and risk management tools from Arcadia.

People

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Federal health IT vendor DSS names Christopher Kunney (Coker Group) chief of strategy and business development and Roy Hammar (Cerner) chief of client engagement.


Announcements and Implementations

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The National Council for Behavioral Health and disaster relief non-profit Americares pilot a text-based messaging program at eight Texas health clinics that uses patient engagement software from Epharmix to help patients with medication adherence.

California-based HIE Manifest MedEx and HBI Solutions develop MX Analyze, a predictive analytics tool designed to help providers manage high-risk patients and care transitions.

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A new KLAS report says that the patient engagement ecosystem is a complex and overwhelming area of health IT that spans 80 capabilities and “a slew of vendors claiming to offer them.” KLAS analysts didn’t interview clients in this case – they compared vendor claims to provider priorities. Among vendor-agnostic products, Allscripts, CiperHealth, and GetWellNetwork offer multiple solutions that align with market priorities. EHR vendor patient portals from Epic, Athenahealth, and NextGen, even though their use is limited, meet the key provider demands for bill payment and self-scheduling. Sonofi Health and PCare lead in the interactive patient systems category, Orca and Luma are notable outreach vendors, and Salesforce and Docent Health perform well in the broad category of CRM, rounding, and wayfinding. KLAS notes that providers reap most of the benefit of these systems, with only 20% of vendors claiming improved clinical outcomes.


Government and Politics

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The VA gives all veterans access to their medical records via Apple’s Health Records app following an earlier limited rollout.


Privacy and Security

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The Government of Nunavut in northern Canada prioritizes getting its health department’s Meditech system back online after a DoppelPaymer ransomware attack over the weekend crippled digital services across its networks. Officials anticipate returning to normal operations within a week.


Other

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Researchers at Emory University in Atlanta find a direct correlation between opioid abuse-related tweets and overdose deaths in several Pennsylvania counties. The researchers hope to further refine their machine-learning algorithm to help public health officials monitor opioid abuse within certain populations.

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Kyruus surveys 1,000 consumers for the third year in a row to better understand their healthcare access preferences. A few findings:

  • Consumers are relying more heavily on hospital websites than in years past when it comes to searching for healthcare information.
  • Scheduling appointments by phone, while still the dominant method, is losing losing ground to online booking.
  • Consumers care more about insurance acceptance and clinical expertise than a health system’s reputation or appointment availability.
  • Thirty-three percent of respondents say they would switch providers for access to virtual visits.

Sponsor Updates

  • EClinicalWorks and HealthCrowd will exhibit at the TAHP Texas Covered Health Care Conference + Expo November 11-12 in Austin.
  • Ensocare will exhibit at the 2019 Leadership and Physician Advisor Conference November 15-17 in Miami.
  • EPSi will exhibit at the HFMA Region 9 Annual Conference November 10-12 in New Orleans.
  • Formativ Health will sponsor the Wounded Warrior Project Carry Forward 5K November 9 in Jacksonville, FL.
  • Patientco celebrates new office space in Atlanta.
  • Healthwise, Imprivata, and Intelligent Medical Objects will exhibit at NextGen UGM 2019 November 10-13 in Orlando.
  • Hyland names the State of Minnesota Department of Health as the winner of its 2019 Government Innovation Award.
  • InterSystems debuts its PulseCast podcast, “John Halamka: Making the Most of Decentralized Data.”
  • Definitive Healthcare SVP of Strategy Kate Shamsuddin wins the Worcester Business Journal’s Outstanding Women in Business Award.
  • Glytec publishes a new study focused on the “Current State of Inpatient Diabetes Care and Glycemic Management.”

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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EPtalk by Dr. Jayne 11/7/19

November 7, 2019 Dr. Jayne 2 Comments

It’s been a crazy week, with a couple of days of travel being paid back with hundreds of emails in my inbox. Even as I unsubscribe and use filters, it seems like there is always something going on that generates more correspondence than it should (think reply-all apocalypse).

I’d love to sell services around creating an effective email policy to some of the organizations I work with. It seems to be a skill that is sorely needed both in the commercial space and in the volunteer space. I’m getting ready to head out for a week-long trip and am trying to pre-tie loose ends, and predicting what might need to be taken care of in my absence is always a challenging exercise.

The Drug Enforcement Agency is one of the major causes of increased email traffic in my inbox. It seems like my recent renewal has triggered enrollment in a number of mailing lists that have to be individually stamped out like a game of Whack-a-Mole. Some of them have forced me to go through the unsubscribe process twice to get them to stop. The mailing list preferences have names like “Prescribers” and “Prescribers-All” so you don’t know what you’re really unsubscribing. I like to have as little contact with the US Department of Justice as possible, so I hope I have finally gotten things back to where they were prior to my renewal.

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Registration is open for the 2020 ONC Annual Meeting, with the theme of “Connecting Policy and Technology: Bringing the EHR to the Patient.” The event will be held in January 2020 in Washington, DC. The published agenda only shows the various time blocks for sessions, with a note that the full agenda is coming soon. Personally, I like to see the agenda before I plunk down money on a conference, but I’m guessing that most of the people who attend the ONC meeting are going to go regardless.

I enjoy attending conferences as a way of learning new things and engaging with people in person, but the cost of many of them poses a barrier. Maybe we should start a “Send Jayne On the Road” conference fund so I could report from around the country and across the globe. Warm locations preferred between November and February, of course.

CMS is plugging information sessions for its new Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Model Options, which are part of the Kidney Care Choices (KCC) model. They are targeted towards nephrologists and dialysis facilities along with accountable care organizations that focus on kidney disease, and build on the Comprehensive End-Stage Renal Disease Care Model structure.

It’s good to see a model with a goal to delay the need for dialysis and encourage transplantation, but the reality is there is still a shortage of kidneys out there. We also need to be spending money to reduce the causes of chronic kidney disease, including diabetes and hypertension.

I recently attended a local health IT event and sat with some students. One of them was from a different country and is in the US pursuing a master’s in public health. His big observation is that public health in the US is far less prominent (and less well-funded) than in his home country, which was a surprise because he had assumed that because the US has “rich resources” that we would have it together.

Public health often gets the short end of the stick. I learned a great deal about public health informatics while working towards my clinical informatics board certification. It’s a fascinating field that has great potential to positively help people.

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If you haven’t received your influenza vaccine, there’s still time, but the season is ramping up. Flu season officially began October 1 in the US and roughly two percent of all visits to healthcare providers in the past week were for influenza-like illnesses.

We’re seeing quite a bit of it at our facility, and even though the flu tests may be negative for influenza A or B, if it walks like a duck, quacks like a duck, and has a bill and webbed feet, we’re treating it as such. Louisiana leads the nation at reporting “widespread” flu activity, so make sure you’re prepared if you’re headed to the Big Easy.

Patients are always surprised when I quote flu statistics to them. I receive a weekly virology digest from our medical center’s infectious disease division that shows how many patients were tested and which viruses are prevalent in the community. I want my patients to know that we’re using evidence and data in their care and not just our best guess.

With Google recently announcing the decision to buy Fitbit, I’ve been asked a couple of times what I think about the company’s role in healthcare. A recent CNBC piece quoted Google Health head David Feinberg outlining plans to bring Google search technology to bear against EHRs as well as generally improving health-related searches on Google. Feinberg spoke at the recent HLTH conference and outlined some pretty far out sounding uses for auto-complete in the EHR as well as better enabling surgeons who visit YouTube before operating on patients.

I like my physicians to already have necessary skills before working on me and am not sure I want them watching a video to know what to do before they walk in the room. I just referred a patient to the emergency department this week because she needed a procedure that I haven’t done in 20 years and my physician assistant hadn’t done in 15. Although it was tempting to watch a refresher video and give it a go, that’s not the best care for the patient.

My clinical care recently has been challenging enough, and the root of much of what I have been seeing is our broken and chaotic healthcare system. One morning I saw a patient who had been briefly paralyzed after a fall, but who came to urgent care because he didn’t have insurance and didn’t want to go to the emergency department. The diagnosis was an unstable neck fracture that could have led to more permanent paralysis at any time, and yet he still refused our calling an ambulance to take him to the ED.

The following day, I saw a patient who qualified for Level 1 trauma status after a vehicular-pedestrian hit and run who also came to the urgent care because he didn’t have insurance. He at least consented to the ambulance transfer. The ED physician called me to give follow up and was shocked that patients like that come into the urgent care. We see them all the time, and unfortunately their visit to us just adds another layer of cost to the system. It’s a sad commentary for healthcare in general.

What’s the saddest commentary on healthcare you’ve seen recently? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 11/7/19

November 6, 2019 Headlines No Comments

Compugroup shortlisted in Agfa Gevaert unit sale: sources

Reuters reports that Compugroup Medical is one of two top bidders for Agfa’s health IT business.

Health Records on iPhone now available to veterans across the US

Nearly a year after announcing the project, the VA gives veterans access to their medical records via Apple’s Health Records app.

HCAP Partners Announces New Investment in TCS Healthcare Technologies

Private equity firm HCAP Partners makes an undisclosed investment in managed care software vendor TCS Healthcare Technologies.

Health IT from the Investor’s Chair 11/6/19

November 6, 2019 Investor's Chair 2 Comments

The Investor’s Chair Returns to HLTH: The Good, The Bad, and the Kind of Weird

Loyal readers might recall I attended the inaugural HLTH Conference last year and, as I wrote here, came away pleasantly surprised. I eagerly returned to see how its second edition would play out.

The questions bubbling through my mind on the flight were: Is it really, as its website claims, “the largest and most important conference for health innovation?” Can it really cope with “6,000+ attendees and 6,000+ 1:1 Meetings?” And once again, do we really need another conference?

Our esteemed Mr. HIStalk told me when I e-mailed from on site that he was “slightly surprised that HLTH rebounded after its disastrously ill-informed decision to immediately follow HIMSS in Las Vegas.” With all due respect, I disagree with that assessment. As I wrote last year, HLTH follows the formula of its founders’ previous and very successful conferences, Money2020 and ShopTalk. Part of that formula, I believe, is making it easy for people to come and party together.

Don’t get me wrong, I have no great love of Vegas except when comparing it to Orlando, but it’s easy to get to, relatively affordable, and perhaps most importantly, exceptionally easy to navigate, with lots of venues near the convention center to drink, dine, and debauch. If it ain’t broke, they won’t be fixing it.

HLTH already announced Caesar’s Palace for next year (rather than Boston, as had been previously announced). I don’t view Vegas as a misstep, but exceedingly on-brand. For HLTH, not for actual health – I get more secondhand smoke there then the rest of my year combined.

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If nothing else, HLTH thrives on branding, and in doing so, creates for the most part a great user experience. I arrived at the MGM Grand and was greeted by its famous lion, this time dressed for the occasion! I checked in and was handed a Livongo-branded key. HLTH is in many way, a perfect conference for Livongo to be a top sponsor – interesting, yet slightly over-promotional. LVGO is the lowest market cap company sponsor, and why UPMC as a not-for-profit health system sponsored at the top level is another interesting question.

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I opted to arrive after Sunday’s sessions and accompanying party and so began my day on Monday, walking through a dark tunnel and new age music to emerge at the light at the end of the tunnel ,which was of course HLTH. Perhaps a bit dramatic, and I honestly don’t know if this was supposed to represent birth (long, womblike corridor) or even death, but it definitely was … kind of odd, at least to me. Someone later said app company and sponsor Calm was responsible, but absent any branding, it just seemed rather outré.

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Speaking of kind of odd, this was the first time I’d seen hair-cutting options in an exhibit hall! Perhaps I’m old school, but I get my hair cut before conferences. Both men’s and women’s sides were occupied most times I walked by. Someone told me a presenter mentioned them on Sunday, pointing out that for poorer communities, barber shops and salons were key places to impact social determinants of health (SDOH was, of course, a big theme at HLTH), but given that I saw no obvious branding nor could the haircutter I asked tell me who sponsored, I’ll have to take their word for it.

Reports on content were more varied than last year. One attendee described them as, “more like TED Talks than actionable ideas.” Another observed more commercials from the podiums as opposed to accurate portrayals of what the companies are actually accomplishing.

In talking to a mid-level marketing professional of an exhibiting company, he said he would definitely exhibit again next year, but the attendees weren’t his true target market like those who attend smaller, benefits-focused events. Rather it was “vendors talking to vendors,” albeit 70% vendors as opposed to the 90% he had feared it might be.

That said, much of the target market here is folks who serve vendors (bankers, investors, and consultants) rather than folks who actually purchase goods and services from vendors. If you’re looking for the former, though, this is a great place to find them.

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More of the good. The exhibit hall wasn’t the overwhelming boat show that HIMSS has become. Booths were smaller and it was possible to have a conversation. As with last year, there were also meeting pods on site outside the exhibit hall for those that sponsored them, of course. Optum had a fabulous outdoor patio area with conversation spaces, fresh squeezed orange juice, and a coffee truck with branded foam.

When it came time for the reception, this Sonoma-dwelling correspondent was actually quite pleased with the quality of the wines on offer. Finding all this networking and disruption all too stressful? Aetna’s booth had actual certified emotional support dogs to pet and cuddle. I tell you, people just don’t realize how hard we all work to make healthcare accessible!

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Some of the bad. Elements were a bit too contrived, self-impressed, and vaguely, as another few attendees commented, millennial. For example, one hopes people are actually there to work, and networking definitely counts as working. That means, in my opinion at least, that a DJ blaring is not a value-add. This unfortunate music trend persisted throughout. The full conference sessions had intro music that I could feel in my chest and fillings, and worse still, at the very end of HLTH was the reception for Women in HLTH. It’s an important event with unfortunate timing – you’re really important, but also dead last after the majority of attendees have cleared out.

After the final panel, it was time for a brief networking reception, and again there was music playing throughout and clearly above background level. News flash – we’re here to connect and learn and excess music does not help! (#getoffmylawn)

More importantly, beyond the company commercials from the speakers, there was an element of self-congratulatory behavior that I found somewhat off-putting. John Moore of Chilmark Research, an industry analyst I admire greatly, commented in his excellent blog post that the best talk was Mark Cuban’s, in which he told people that they “weren’t truly disrupting their business.” 

I think that’s a real problem with healthcare today and HLTH is just a more glaring symptom. With all due respect, while healthcare is in dire need of disruptive change, disruption for its own sake is hard, and in fact, dangerous. I’ve spent the bulk of my career observing healthcare IT and have learned the hard way that the challenge is adoption, not disruption. And even adoption is hard.

An article on Stat News last April said it more eloquently than I can: “The most glaring deficiencies don’t stem from a lack of technology or creativity or innovation. Many shortcomings could be solved by adopting widely recognized best practices and committing to a handful of mundane, lifesaving processes. Think surgical checklists, timely removal of central venous catheters, and adoption of safe birth practices.” But not only are those ideas not disruptive, they’re unlikely to raise venture dollars any time soon.

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More of the weird: Even more startling than the long dark corridor or the haircut opportunities, I personally thought using toilets as branding sites was kind of bizarre! “Don’t Miss,” heh heh, yeah, not so much. There were similar signs on stalls and over sinks, but this was a bit too much (and I like puns as much or more than the next blogger.

The bottom line: once again I ask, what is the future of “The Future of Healthcare?”

As I observed last year, from an attendee perspective, HLTH was incredibly well organized. Helpful staffers abounded, there were plenty of places to convene along with a plethora of phone charging banks (sponsored, of course), and a definite “who’s who” vibe going on. More than one attendee “bemoaned” the fact that this was likely becoming another “must attend” event like the JP Morgan Healthcare Conference (JPMorgan).

Mr. HIStalk himself observed, “My working theory as a cheap seats observer: HIMSS is for selling product, HLTH is for selling investors, and JPMorgan is for selling companies.” I actually think this observation is spot-on and makes perfect sense. HIMSS is sponsored by vendors, HLTH is sponsored by a venture fund, and the JPMorgan Conference (née the H&Q Conference) is sponsored by a bank whose most profitable activity is advising on mergers and acquisitions.

To put it another way, HIMSS is Macy’s (at best), JPMorgan is Mall of America for healthcare (pharma, biotech, devices, services, HCIT, and more), and HLTH is more like Nordstrom’s. As an aside, Health Evolution Summit is kind of like a pricy boutique on 5th or Michigan Avenue.

The bottom line on having multiple conferences is that I don’t think that the hotels and restaurants of the City of San Francisco need fear attendance loss to Vegas, rather that people might have a few more brief “meet and greets” at HLTH, allowing for more substantive meetings nine or 10 short weeks later. Recall that only a small percentage of those who “go to” JPM actually attend the conference itself; rather they hang out in coffee shops and bars and meet with other folks who come in for the exact same reason.

Overall, I admire both the organizers and their investors. We didn’t know we needed this conference until they created it,  kind of like mobile data and iPads. HLTH more than met my expectations and I’m glad I went. The conference was well attended and had a good range of professionals from all sectors, younger in many ways than HIMSS or JPM, which is a nice contrast. It won’t replace other industry conferences, but it will augment.

That said, a common complaint I heard was that it was less intimate than last year. I heard a rumor of over 10,000 expected next year, and maintaining user experience and a degree of intimacy in the face of that kind of growth will be a real challenge. As another conference organizer has observed, everyone wants intimacy, but everyone also wants to be able to attend, and I don’t know how to reconcile those two goals.

On the other hand, I haven’t successfully sold two earlier conferences for astronomical sums, so they clearly know things about this topic that I do not. Will it be like other short lived events like MS-HUG (remember when it had its own conference?) or TEPR (which I’d frankly forgotten until reading about it in John’s post’s comments), or will it become the newest pilgrimage that FOMO (and fun) requires people to show up for? I look forward to 2020 back in Vegas to see how it evolves.

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Ben Rooks has now attended every HLTH, 25 HIMSS, 10 HESs, and JPMorgans as far back as its H&Q Days. He’s also been proud to write this column for HIStalk for over a decade, albeit not often enough, so feel free to e-mail him questions or ideas for future installments. He also really enjoys his day job at ST Advisors.

HIStalk Interviews David Lareau, CEO, Medicomp

November 6, 2019 Interviews 2 Comments

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

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Tell me about yourself and the company.

Medicomp provides a clinical engine and tools to use it that provide physicians, nurses, and other clinicians what they need at the point of care so they can do their jobs. We give them what they need when they need it, stay out of their way, and let them focus on the patient. I discovered Medicomp in 1992, joined the company in 1995, and have been CEO for about 10 years. We are continuing to build our content and tools to support point-of-care use for better patient care.

How would you characterize the EHR industry and how it has changed?

Over the last few years, I would say the last 10 years, the focus has been on getting the money. Getting the $30 billion to $40 billion that the government gave out to promote and make electronic records ubiquitous in the industry. That’s been done, but I don’t know that it has moved the needle at all in providing better patient care.

Now the industry is being forced to turn away from the number of transactions processed or encounters documented to, how well are we taking care of these patients? How do we report that? How do we measure it? How do we make it happen? How do we prove that we did it? It’s a major change to try to make these systems usable for clinicians at the point of care.

Are EHR vendors committed and capable of making usability what users want it to be?

I’m not sure they are. As part of my evidence for that, people seem to be thinking they can rely on artificial intelligence, NLP, and machine learning to solve the problem of usability. Or the use of scribes. That indicates to me that they recognize that they can’t do what it takes to make these systems, the way they’re currently constructed, usable for physicians at the point of care to meet all the requirements that they need to. They need to be efficient, effective, they need to meet these quality metrics, and they need to do it without getting in the physician’s way or slowing them down.

They seem to be turning to, “OK, ambient AI. Say anything you want and the machine will figure it out.” The problem with that is that the machines are taught by programmers, not necessarily by clinicians. So I don’t see where the ball has been moved toward clinical usability much at all in the last 10 years.

Is it fair or unfair to say that EHRs cause burnout?

It’s fair to say that EHRs cause burnout, because EHRs, as currently constructed and implemented, weren’t designed with the patient or provider in mind. They were designed to maximize reimbursement and track transactions. Clinicians they have this reputation as being difficult to work with because they are the most highly trained knowledge users in the world and the systems they are using actually dumb them down. They get no benefit from it. They pour stuff in there and they get nothing out of it that helps them, because they already know what to do. Just get out of my way and let me do it.

What value can be added to a vendor’s EHR to make it more useful and satisfying to clinicians without having the EHR vendor themselves making changes?

Every EHR should have a problem list. If there’s something in the problem list, you ought to be able to just click on that problem and see everything in the patient’s chart that’s relevant for that problem. For diabetes, you ought to be able to see on one screen the lab results, medications, symptoms, relevant family history, relevant past procedures, et cetera.

We provide a huge clinical engine that has about 120,000,000 links between problems and the other clinical concepts related to that problem. That helps people get clean data in, use it, and see it at the point of care, rather than having to go to six different places in the EHR to look at labs, meds, and procedures. It needs to be pulled together. Physicians, because of their training and experience, already know what they need to see. They’re highly trained. They know it. Just give it to them.

We’ve been working with clinicians for 41 years to say, if you’re thinking about diabetes, what do you need to see? If you’re thinking about chronic renal failure, or thinking about this other issue, what do you need to see? They know it. Just give it to them and they can focus on the patient in front of them at that moment without having to navigate through the EHR to find every little piece of information.

How has private equity and other forms of investment changed healthcare lately?

You had a nice article on Jonathan Bush where he said, boy, once you let them in the tent, they own the tent. There’s really no room for anybody else. They have a three- to five-year time horizon to get in there, get things lean, flip it, and get out. Typically. Typically. Now, a lot of them say they’re long-term investors.

We’ve been doing this 41 years. We’ve decided to keep it, and we will continue to keep it, private and closely held so that we can continue to focus on doing what we’re doing and not be distracted by the flavor of the month. “Why aren’t you guys doing NLP? Why aren’t you guys doing AI?” We have a form of AI. Our engine was built using doctors to say what’s relevant, but we don’t talk about it as machine learning. It was actually taught by our clinicians.

If we accepted private equity money or outside investors at this point, we would lose our focus on the long-term vision, which is providing tools to let clinicians provide better care for patients at the point of care. That’s really what we’re trying to do here. Everybody has their own idea of the latest thing they should focus on. We stick to our knitting.

Is it hard not to get wrapped up in the AI buzzword that everyone suddenly claims to be using in their old products?

It’s tough. What is competition? Competition is anything that causes people to not engage with you at this point in time.

People have been telling me for three to five years that, “In three to five years, AI and machine learning will be able to do what you do.” That’s competition for us, in that it causes somebody to say, OK, we will wait and see what happens with that. People are now getting used to the fact that even if you use artificial intelligence and machine learning that’s programmatically-based rather than clinically-based, if you put garbage into these systems, you get garbage out. What error rate are you willing to accept?

We don’t try to compete with AI or machine learning. I don’t want to sound like a troglodyte. It’s valuable in identifying associations from large populations of data, saying, “We need to do more of this. We need to do more of that. This is happening in our population.” But for an individual patient, at any point in time at the point of care, I don’t think it’s going to be ready any time soon.

What are the secrets of working with EHR vendors instead of trying to compete against them?

You have to provide something of value to them and to their users. We provide a clinical data capability that they don’t have otherwise. 

One of the secrets is when they say, “We have to have certain technologies. We need Angular. We need React. You have to do Docker containers. You have to host it in the cloud. It must be able to be  web-based. We don’t want to use your UI, we just want to call out to it and have it linked,” you have to  make sure that whatever tools you create allow them to stay in place to do all the things that they do well. Patient registration — we don’t do that. Storing of data — we have data services that pass it back and forth.

You’ve got to be willing to not enforce your vision of what their application should be. You’ve got to make your tool customizable enough and flexible enough and you’ve got to constantly redevelop your technology so that it meets the latest requirements for integration with these systems.

With these systems, the concrete is poured. They’ve got a bridge in and the concrete is poured. They want to improve their roadway? Yes, we can put down parts of a roadway, but we can’t rebuild the bridge, and nobody wants us to. So you’ve got to be willing to be part of their implementation. And in our case, our clinical stuff becomes a core piece of what they do, but it doesn’t look like it is to their customers. It just does what it needs to do and sits there. You’ve got to make it work in their environment.

Health IT vendors are making splashy announcements about embracing Amazon Web Services, Google Cloud, or Microsoft Azure and using their tools for AI and speech recognition. How will that change your business?

We’ve already begun part of that. We already have people using AWS and Microsoft Azure to host our stuff, or their applications with our stuff in it.

We will probably be asked very shortly to provide some sort of a clinical relevancy service to some of these people who are making announcements so they can find anything they want with just one or two words. For clinicians, finding anything you want means finding the things that are relevant to that, given the fact that somebody has asthma.

Over time, probably in the next two or three years, we will probably have to split our stuff into separate consumable services, one of which we’re already doing with our HCC and Medicare Advantage service, so that people who aren’t even using our concepts, engine, or terminology can do risk adjustment reviews if you just give a problem list based on SNOMED or ICD-10.

Microservices was a big buzzword a few years ago. We’re probably going to have to be willing to work with not just vendors, but suppliers of technology to those vendors, by allowing people to consume services from our engine, but not necessarily the whole thing.

Google has expressed interest in creating an EHR search engine, but it seems like it would find “patient denies chest pain” just as readily as “patient complains of chest pain.” How important is the contextual element of the search?

There is no question that natural language processing, based on noun phrases alone, is not going to work in medicine. You need context, you need to know relevancy. Is pain relevant for somebody with asthma? Yes, chest pain. What about wheezing? Did it start suddenly or not? The more that people drill down into this, the more they realize that you really need the clinical context within which the phrase you’re looking for exists.That’s a big part of what we provide.

What do you expect to see at HIMSS20?

A lot of the vendors complain that the CIOs, CMOs, and CMIOs don’t go to HIMSS. I think that’s true more and more. If they already have a platform — Epic, Cerner, Meditech, Allscripts, some of the big guys — there’s nothing they can do about it. They’ve got it. They might go to HIMSS looking for the ancillary vendors to add on certain products. We’re still seeing those people come through.

Ten years ago, health systems would send like 15 people, and say to the 15 people, “Fan out. You check this out, you check this out, you check this out.” You’d see them meeting at breakfast and planning their day because they were going to switch vendors. They were looking for a vendor. You don’t see that much any more. Because we’re not there to replace vendors, we’re there to have our stuff in as additive value, the fact that those people aren’t there doesn’t affect us so much any more.

Going into HIMSS last year, I was thinking about downsizing the booth. But by being there and by making a stronger statement about what we do – “We fix EHRs” — people said, “Finally, somebody says what they do. No buzzwords.” We met two major new accounts and opportunities that we have license agreements with. I decided for the first time to splurge and get a booth on the main aisle, because if you’ve got a good message and you know who your target market is, it’s still worthwhile for people like us. But boy, there’s a lot of noise. 

Half the team you bring is there just to figure out, “Somebody just stopped by the booth. Are they serious, or are they not?” We’ve been going to HIMSS since 1996, so we’ve gotten pretty good at that.

It’s worthwhile for us still because we’re solving a problem that everybody has, and they know they have, which is clinical usability. We’ve managed to hone our message on that in the last few years, so it’s effective for us. But if I was going in there for the first time, it would be like a deer getting caught in the headlights.

How do you see the future of the company?

We’ll continue to do what we do. We’ve been doing it since 1978, 41 years. We’re really starting now to benefit from people realizing, “We’re not just tracking transactions any more. We’ve got to manage the patients better. It takes really good data to do that. We’ve got to make it usable at the point of care. What are we going to do? What are we going to do?”

This, I think, is our time. We’ve got to stay focused on what we do. Going after outside investors, changing ownership, changing leadership would just distract us from our mission. One of my main challenges is identifying and nurturing the next generation of leadership here, because we’re going to continue to do what we’re doing. I look at the senior people at companies to see, how long have they been there? How many generations of those people have they been through in the last 10 years? If it’s more than two, that’s a bad sign for continuity. The only way we can continue to do what we’re doing is by continuing to do what we’re doing.

Morning Headlines 11/6/19

November 5, 2019 Headlines No Comments

Medical E-Records Provider Scores $19.5M IP Verdict in Miami

A federal jury orders behavioral EHR vendor ZenCharts to pay rehab EHR provider Kipu Systems $19.5 million in damages for stealing its trade secrets.

800 jobs may be headed back to Wake Forest Baptist. Hospital to bring billing services in house, rehire employees

NThrive will eliminate 839 jobs in central North Carolina following Wake Forest Baptist Medical Center’s decision to bring registration and billing back in house after signing a seven-year outsourcing deal with the vendor in 2017.

Failure to Encrypt Mobile Devices Leads to $3 Million HIPAA Settlement

University of Rochester Medical Center (NY) will pay $3 million to settle OCR charges resulting from the 2013 loss of an unencrypted flash drive and the 2017 theft of an unencrypted laptop.

Healthify Raises $16 Million to Integrate Health and Social Services

Social services coordination software vendor Healthify raises $16 million in a Series B round led by SV Health Investors.

Walgreens explores going private in what could be largest LBO in history

Walgreens is reportedly talking to some of the world’s largest private equity firms about taking the company private in a leveraged buyout.

News 11/6/19

November 5, 2019 News 9 Comments

Top News

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A federal jury orders behavioral EHR vendor ZenCharts to pay rehab EHR provider Kipu Systems $19.5 million in damages for stealing its trade secrets.

The court found that a now-closed rehab center signed a contract with Kipu 2013, then shared the design details of that product with ZenCharts so it could develop a competing product.

Evidence was introduced in which one of the rehab center’s owners said in a 2012 email, “I’m building an EMR for treatment centers” and discussed the possibility of reverse engineering Kipu’s product.

The lawyer for ZenCharts unsuccessfully argued that the rehab center’s contract didn’t contain a non-compete clause, that Kipu’s EHR didn’t contain anything novel, and that a substantial verdict would bankrupt ZenCharts and increase the costs of addiction treatment.


Reader Comments

From Palate Cleanser: “Re: Cerner Scandinavia. Heard it is shutting down its Norway offices. Related to massive delays on two Swedish projects, or just more cuts?” Unverified. A Swedish newspaper recently reported that the Cerner project in Västra Götaland has been delayed for a year because Cerner hasn’t finished work on localizing Millennium to accommodate data laws.

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From Banal Boy: “Re: your former 10×10 booth. HIMSS is pushing them specifically, maybe because as you mentioned they aren’t selling well.” HIMSS lists the benefits of the tiny booths that few attendees visit (five exhibitor badges and a booth guide listing are pretty much it). I should ask for a discount for buying several, then packaging them up with an HIStalk sponsorship that provides three and 365 days, respectively, of exposure. I could pitch them as a “neighborhood” of HIStalk-savvy vendors who can’t justify the cost of buying a big space that is used mostly by their reps for screwing around with their phones. I even have a Smokin’ Doc standee left over to serve as block captain. I was searching for a micro-booth photo when I rediscovered “The Smokin’ Doc Celebrates a Successful HIMSS,” in which some fun vendor folks took the cardboard character (they named him Dr. Brandon Pierce) out on the town in Las Vegas at HIMSS18, still one of the funniest things I’ve run here.

From Bookworm: “Re: health IT authors. This new one clearly used a vanity publisher.” I’ve seen a few books by health IT folks who hired vanity publishers that create low-quality books from whatever the “author” sends them, as long as one of the items is a check. Some vanity publishers repackage someone’s old reports and blog posts, conduct a short Q&A interview, then dump it all together into a “book” that requires no author effort. I suppose there’s nothing wrong with that, although labeling oneself an “author” on LinkedIn or Twitter is a bit of a stretch since it’s not like a publisher declared their manuscript worthy of their time and investment, then professionally edited and marketed the result and paid sales royalties accordingly.

From Snowflake Melter: “Re: UCSF doctor’s editorial on EHR screen wording. You failed to editorialize.” I think the doctor — whose LinkedIn suggests that she’s around 32 and considers writing, presenting story-telling shows, and podcasting as key elements of her identity – might have been unwise in complaining publicly about her employer’s tools and processes. She says Epic’s use of the word “deficiencies” is insulting, perhaps unaware that the term – which refers to the chart, not the chartist – was around long before hospital computer systems. She adds that  Epic doesn’t coddle her enough in failing to present “small islands of empathy” and thus “will continue to contribute to the profession’s growing sense of despair” (do SAP and Excel offer such user stroking?) Perhaps her insecurities are excessive, maybe she was short on something to write about, or perhaps she thinks she has life figured out two years out of residency, but crying to the public that Facebook (whose CEO’s name adorns the hospital that sends her checks) gives her birthday greetings that Epic doesn’t suggests that if this is the biggest issue with her job, she’s doing pretty well.


HIStalk Announcements and Requests

I bought a no-name, $20 128GB flash drive from Amazon that, perhaps predictably, didn’t work and couldn’t even be repaired or formatted by Windows. I was going to write it off as a lesson learned, but clicked Amazon’s “return” option for the first time ever, which is pretty slick. I chose the option to drop the item off at a UPS Store, where I will show them the QR code on my phone that Amazon emailed me and then I will walk away – they will box the item up, label it, and ship it back to Amazon. I’m ordering a different drive, but reviews for most are mixed even with the big-name products– people report premature failure, abysmally slow write speeds, and being locked out of their files. My new external hard drive won’t work in this case since I need to copy files from Mrs. HIStalk’s Mac and the file system isn’t compatible with Windows. Dropbox may be the right answer.

Thanks to the following companies that recently supported HIStalk. Click a logo for information. I see several new names on the list, so special thanks and welcome to the newcomers.

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Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Allscripts announces Q3 results: revenue up 3%, adjusted EPS $0.17 versus $0.16, beating Wall Street earnings expectations but falling short on revenue. From the earnings call:

  • The company says work on the EHR it is developing with Northwell Health will focus on user interface and workflows over the next six months, then development on top of the Avenel product, followed by Northwell’s implementation on the way to commercialization.
  • The Northwell extensions contributed zero to bookings since it was not incremental business. It flows into backlog.
  • Annual revenue from the Veradigm business is $150 to $175 million.
  • The company expects to see revenue from its NextGen partnership scale up and is talking to other EHR vendors about similar arrangements.
  • Allscripts responded to an analyst’s question about the technology involved in the Northwell project: “We’re definitely single database, multi-tenant, pure cloud technology. The focus is on ambulatory outpatient and so the workflows that go with that. So this is not an exercise to effectively integrate TouchWorks and Sunrise as we know them today, but this is a recognition that the user base would like a more user-friendly tool and we think they should do that with modern technology.”
  • Paul Black declined to answer an analyst’s question about a revenue share or marketing agreement with Northwell for the new EHR being developed.
  • President Rick Poulton says the company’s joint development effort with Northwell will not increase R&D spending.
  • The company says Cerner’s move to Amazon Web Services could benefit Allscripts since any Cerner customer that faces switching costs might need to issue a board-mandated RFP.

A private equity firm acquires EDCO Health Information Solutions, which offers technology that converts unstructured patient data to EHR-ready information.

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A Cerner spokesperson provided further information about my interpretation of an earnings call comment by EVP/CFO Marc Naughton, who said in discussing Adventist Health’s termination of its revenue cycle outsourcing agreement, “We aren’t going to do the full outsourcing.” I took that to mean that Cerner was exiting the RCM outsourcing business, but she says Naughton was referring to RevWorks, not revenue cycle management outsourcing (and I’ll admit that thought those were the same thing). The spokesperson explains:

At this point, the future of that business unit has yet to be determined. During the earnings call, Marc Naughton, Cerner’s Executive VP & CFO explains, “We’re going to look at the remainder of that revenue cycle business. If it doesn’t meet our selective criteria relative to margins, we’re going to determine what needs to be done with that business.”

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Reuters reports that Walgreens is talking to some of the world’s largest private equity firms about taking the company private in a leveraged buyout. However, many PE firms aren’t convinced about the company’s business prospects, its $17 billion of debt, and their need to partner with competing PE firms to come up with the $55 billion or so that the company is worth today. The Italy-born CEO of Walgreens, Stefano Pessina, holds shares worth around $9 billion.

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NThrive will eliminate 839 jobs in central North Carolina following the decision of Wake Forest Baptist Medical Center (NC) to bring registration and billing back in house after signing seven-year outsourcing deal with NThrive in 2017.


Sales

  • Interactive patient systems vendor PCare chooses Redox for integrating its system with EHRs and other hospital platforms.

People

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John Daniels, MSA (HIMSS Analytics) will join Building Industry Consulting Service International, a Tampa-based IT infrastructure professional association, as executive director and CEO.


Announcements and Implementations

A Black Book survey of hospital security professionals finds that nearly all respondents think that their security efforts are falling short and budget constraints are limiting their ability to protect their systems, leading Black Book to conclude that things will get worse in 2020. 

Collective Medical releases Flags, which allows health plans and ACOs to share member population information with point-of-care teams, with a use case example of patients who are concurrently taking opioids, benzodiazepines, and muscle relaxants.

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KLAS and CHIME review the use of AI in healthcare, providing a working definition (which would probably exclude most of the vendors who see AI as a marketing rather than a technical term) and a look at six vendors, only one of which (Jvion) has enough customer responses to earn a full rating and even it earns only mediocre customer satisfaction. DataRobot and KenSci earned good scores, IBM Watson Health is improving but offers questionable value, Health Catalyst has the strongest healthcare expertise and diverse use cases, and SAS is being increasingly used for predicting by academic medical centers. KLAS warns that using AI in healthcare consumes a lot of effort to prepare the data, requires maintenance to keep models viable, needs department buy-in and effort to improve outcomes, and requires a culture shift to get employees and clinicians to trust its recommendations.


Privacy and Security

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Slate magazine runs an excerpt from a new cybersecurity book that describes the NotPetya malware, which caused $10 billion in damage in 2017, including $870 million at drug maker Merck alone. The featured chapter involves Nuance, which reported a malware-caused loss of $92 million from its extensive transcription system downtime, but notes that hospitals – and thus patients, indirectly – were the real victim as they had to scramble to work around loss of a mission-critical system that directly impacts patient care. It highlights Sutter Health, which accumulated a backlog of 1.4 million patient record changes in the first 24 hours of Nuance’s downtime, which kept piling up over the two weeks Sutter needed to switch to a competitor’s transcription system. The author says Heritage Valley Health System (PA) lost every Windows machine as the malware spread to its systems from a single employee being logged into a Nuance server.

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University of Rochester Medical Center (NY) will pay $3 million to settle OCR charges resulting from the 2013 loss of an unencrypted flash drive and the 2017 theft of an unencrypted laptop. The incidents affected the records of a total of 580 patients. 


Other

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UPS delivers the first CVS Pharmacy prescriptions to customers via drone, dropping medications to two Cary, NC customers from 20 feet overhead. UPS’s UPS Flight Forward will expand the rollout of its FAA-approved drone service, which has completed 1,500 paid deliveries of lab samples at WakeMed Hospital (NC).

ProPublica calls out Dignity Health (motto: “Hello, humandkindness”) for billing one of its nurses $900,000 for the 105-day stay of her premature baby at UC Irvine Medical Center. UC Irvine’s billing department and her insurer assured her that the baby was covered, but she didn’t know that Dignity’s insurance plan required her to sign the baby up on its website within 31 days, so she didn’t. Dignity said it couldn’t make an exception and insisted she pay the bill, but when ProPublica picked up the story, Dignity added the baby to her coverage after the fact.


Sponsor Updates

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  • Avaya team members volunteer with Habitat for Humanity in Morristown, NJ.
  • InterSystems holds its first Healthcare Asia Pacific Customer Meeting in Bangkok, Thailand, with over 100 attendees sharing their digital transformation experiences. 
  • Glytec publishes results of a survey of healthcare professionals who are involved with inpatient diabetes care on the current state of inpatient diabetes care and glycemic management.
  • Audacious Inquiry will present at the Florida Association of ACOs Annual Conference November 7-8 in Orlando.
  • Arcadia releases a statement on predictive analytics and bias.
  • Artifact Health will exhibit at the ACDIS Symposium: Outpatient CDI Conference November 14-15 in Austin.
  • Bright.MD adds new functionality and content to its virtual care technology.
  • Imprivata and Fortified Health Security earn top marks for client experience in Black Book’s latest survey on end-to-end healthcare cybersecurity solutions.
  • CarePort Health will exhibit at ACMA Leadership November 14-17 in Miami.
  • Collective Medical releases new functionality, enabling ACOs and payers to more readily share member population information with care teams at the point of care.
  • Diameter Health publishes a case study titled “Ohio Health Information Partnership Delivers Consolidated Continuity of Care Documents to Support More Informed Clinical Decisions.”

Blog Posts


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Contacts

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Morning Headlines 11/5/19

November 4, 2019 Headlines No Comments

Allscripts Announces Third Quarter 2019 Results

Allscripts reports Q3 results: revenue up 3%, with adjusted EPS of $0.17.

JPMorgan Tests Its Amazon-Berkshire Health Venture on Bank Employees

JPMorgan and Amazon will offer employees in select states access to deductible-free health plans administered by their Haven healthcare business.

Google Health is finally opening up about its plans, and they’re all about search

Google Health VP David Feinberg says the company hopes to develop a search bar that will assist doctors in pulling relevant content from their EHRs, as well as to improve healthcare search results for consumers.

Curbside Consult with Dr. Jayne 11/4/19

November 4, 2019 Dr. Jayne 2 Comments

I had the privilege of attending a prestigious medical school, so I’m always on the lookout for articles about our “rivals” doing something that my alma mater’s institutions aren’t. Johns Hopkins recently launched what may be a first: the Center for Psychedelic and Consciousness Research. They received a $17 million donation from a private foundation and four philanthropists, one of whom is Tim Ferriss, author of “The 4-Hour Workweek.”

The center’s director is interested in studying drugs such as LSD and their potential to treat depression, anorexia, substance abuse, and possibly early Alzheimer’s disease. Apparently Hopkins isn’t the only place who wants to be on this cutting edge. Research is also being done at institutions including New York University, Yale University, University of Wisconsin-Madison, University of California, and the University of Alabama at Birmingham. The center’s director expects that federal funding for psychedelics will increase.

In the article, he speaks at length about a typical psilocybin treatment session. It’s about as far from eating magic mushrooms at a party as one can get. Prior to the session, patients spend up to eight hours with the clinical team reviewing their personal and family histories as well as “life circumstances” to build rapport since the drug can make patients feel vulnerable. On the treatment day, patients receive the medication, lie on a couch, wear eye shades, and use headphones to listen to music. They are encouraged to focus their attention inward while two clinical guides monitor them for six to eight hours. Drug effects typically begin after about 30 minutes and peak a few hours later, then gradually resolve. Patients report sensations that range from love and joy to anxiety or panic. Test subjects often feel that they have a redefined sense of self, which can lead to ongoing positive changes in mood and behavior.

The team has studied the compound in patients with cancer who report decreased depression and anxiety. Patients have reported a positive impact on tobacco cessation efforts. I was surprised to hear that a couple of pharmaceutical companies have shown interest in the drug. I suppose it’s not much different from other drug agents where we don’t entirely understand the mechanism of action or how effective it might be, but companies smell profit potential and so they dive in. Psilocybin has been decriminalized in Denver and Oakland, but those cities aren’t entirely representative of the rest of the US as far as potential for future use.

Of course, this topic has little bearing on the world of healthcare IT, other than use of platforms for research and data aggregation, but it was a good diversion from reading about CMS releasing the Final Rule for the 2020 Quality Payment Program.

CMS continues to tweak the recipes for the Merit-based Incentive Payment System (MIPS) along with the Advanced Alternative Payment Models (APMs) under the guise of reducing burden, responding to stakeholder feedback, and better aligning with various legal requirements. I’ve honestly given on up trying to follow all the MIPS details since my practice remains opted out, and most of my clients have hired full-time people to keep up on everything rather than relying on consultants.

Long story short, various performance categories have been re-weighted, thresholds have been increased, and the finish line keeps being moved. CMS is also finalizing its proposal for MIPS Value Pathways, which of course carry the MVP moniker. I’m sure anyone who participates in the program, which starts in 2021, won’t consider themselves most valuable players in the eyes of CMS.

In other random web surfing this weekend, I saw that Amazon and JPMorgan plan to roll out new health insurance plans for their employees for the 2020 year. The new Haven Healthcare plan will include wellness incentives and will be deductible free. Berkshire Hathaway apparently has a similar pilot. The plans will be offered through traditional insurance providers, including Cigna and Aetna, and may vary slightly depending on the state. The plans are supposed to be more clear than other plans as far as what patients have to pay and how co-pays are applied. Patients will receive rewards for meeting health-related goals.

I had the unique opportunity this weekend to deliver an impromptu education session (which I fear may have turned into a little bit of a sermon) about the state of healthcare delivery in the US. We had some unexpected downtime at my clinical gig, so I was doing some reading on value-based care and my staff asked me what it was all about. Since most of them were in high school when Meaningful Use came about, we did a brief tour through the history of US healthcare, the rise of electronic health records, and what life was like back in the dinosaur days before the internet came into being.

Even though several of them are applying to medical school and have been working in various clinical settings for some time, they had shockingly little understanding of how healthcare is financed here, other than knowing that when patients don’t have insurance, things often get dicey. At least one had experience working in a free clinic and had that frame of reference, but for others, it was eye-opening. Many of the jobs done by aspiring medical students are focused tours through the healthcare system. They might be in the emergency department, at a clinic, or volunteering in a medical office. I can’t imagine that many of them are spending time in the local billing office or following around certified professional coders, although maybe they should be.

They left with some homework assignments. Not only books to read, but also to consider watching “Halt and Catch Fire” on Netflix so they can better appreciate the overwhelming assortment of technology that they can choose from every day. If you haven’t seen it, it’s a fictional tour through the early days of the PC industry and the creation of the internet and search engines. I enjoyed it tremendously during my treadmill sessions earlier in the year. I’m currently watching Charité on Netflix, which depicts the prominent Berlin hospital during the 1800s. The series is in German with English subtitles, and I’m enjoying the depictions of famous physicians of the time.

What random tidbits are you thinking about? Leave a comment or email me.

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Email Dr. Jayne.

Book Review: Lethal Injection

November 4, 2019 Book Review No Comments

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A reader correctly predicted that I would like “Lethal Injection,” which he accurately described as an “informatics murder mystery” that came out in June 2019. That reader is a former colleague of the author and recognized in his book subtle references to the hospital and anesthesiology department in which they worked.

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Author Perry Miller, MD, PhD is an anesthesia professor emeritus at Yale School of Medicine and founder and previous director of the Yale Center for Medical Informatics and its biomedical informatics research training program. He earned his medical degree at University of Miami , an MS at Cal Berkeley in electrical engineering and computer science, and a PhD in computer science from MIT.

It is remarkable that the book is Miller’s first foray into writing anything except research papers. The book is fast paced, flows perfectly, and contains few of the common flaws that often cause me to put a book down for good when the literary awkwardness distracts me from the story.

The book leads off with a flurry of action in which the CEO of academic health system Boston Central Hospital dies while undergoing cardiac surgery at Laurel Hill Community Hospital, which Boston Central is taking over.The anesthesiologist in the CEO’s surgery case is the wife of the protagonist, ED doc Gideon Lowell (the author has a lot of fun with his first name, which isn’t entirely random as he explains in the appendix). She is immediately targeted as a suspect when investigators find that a syringe that was labeled as vecuronium actually contained something else that killed the patient when she injected it. Lowell launches his own investigation, partly because of his patient safety background, but mostly because he wants to prove that his wife wasn’t responsible.

A good page-turning crime mystery starts by introducing several suspects with various motives, then keeps you guessing at who did it until the climactic end. Miller does a great job in weaving a tale of who might have wanted to see the CEO dead. Laurel Hill employees resent having Boston Central know-it-alls running around in preparation for the takeover. Partners in Laurel Hill’s contracted anesthesiology company stand to lose hundreds of thousands of dollars per year via lower academic salaries. Also present are the usual hospital soap opera issues of romantic entanglement, bullying, and doctor back-biting, not to mention hospital greed in performing questionable but lucrative surgeries. In other words, it is realistic.

Miller adds some fun IT flourishes that are vital to the story – spoofed hospital emails, intentional disclosure of EHR patient information, medical records tampering, and the fact that Laurel Hill was ripe for takeover because a botched billing system implementation caused revenue problems (that part of the book isn’t described believably, but it’s not crucial to the story). Then we meet an old friend of Lowell who is a cybersecurity expert who offers to help, a somewhat clueless risk management lawyer, a medical group programmer, a quality assurance manager, anesthesiologists whose character flaws range from laziness to hostility, and an investigative reporter who starts probing into Laurel Hill’s clinical problems.

This book flows really well, contains fun hospital insider knowledge, and probably scares laypeople who will wonder whether hospitals really are greedy and whether doctors could be so vain, insecure, and hostile to employees and to each other. Reading it is a pleasure, not a chore.

A few changes could have made the book better:

  • It’s a relatively short read at 232 pages. That isn’t surprising since publishers aren’t going to allow first-time authors to ramble on for 500 pages like Stephen King since they can’t command his high cover price yet. Keeping it short when the book contains mostly dialog – which takes up more page space —  limits what we can learn about characters that can seem one-dimensional at times, and deprive of us what I’m certain would have been some funny details given a few that were included. But if someone wants to make a “Lethal Injection” movie, which isn’t a bad idea, the book already reads like a screenplay that mostly contains characters talking over a linear timeline.
  • An editor should have caught that it’s vocal “cords,” not “chords,” and a data “breach,” not “breech.” Overuse of the term “sub rosa,” meaning done in secret, was a bit grating. Those are the only examples of questionable editing that I saw, and I usually see a ton, even with the books of best-selling authors. 
  • One set of characters was probed in depth, which was good for calling them out as possible perpetrators, but then their seemingly incriminating act was left dangling as the story raced to its conclusion without them.

“Lethal Injection” grabs the reader’s attention in the first couple of paragraphs and doesn’t let it go until the end, demanding furiously fast reading to see how the story unfolds instead of easy savoring of carefully crafted details and back-stories. I can’t imagine that it’s easy for any author to create such a book, much less a first-time author. It’s quick-hit entertainment that won’t leave you thinking about the characters afterward, quoting new facts you learned, or pondering its hidden meaning or the meaning of life.

Perry Miller is an excellent writer and I’m awaiting his next work.

The Kindle version of “Lethal Injection” was a steal at $0.99. It would be the perfect read for traveling health IT folks who need something engrossing to read on planes or in hotel rooms, knowing that they can pick up where they left off easily if interrupted.

Morning Headlines 11/4/19

November 3, 2019 Headlines 2 Comments

Trump Administration Delays Rule Forcing Hospital-Cost Transparency

CMS delays a requirement that Medicare-accepting hospitals share their secretly negotiated insurance rates in machine-readable format and online.

Fitbit to Be Acquired by Google

Google will acquire Fitbit for $2.1 billion in cash, saying it will bring together the best hardware, software, and AI to build wearables.

The Brooklyn Hospital Center Notice of Data Security Incident

The Brooklyn Hospital (NY) says it discovered ransomware in its systems in July 2019 and found that in September 2019 some of its patient data cannot be recovered.

DAS Health Acquires Automated Medical Systems

Health IT reseller DAS Health acquires competitor Automated Medical Systems.

Monday Morning Update 11/4/19

November 3, 2019 News 13 Comments

Top News

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CMS delays a requirement that Medicare-accepting hospitals share their secretly negotiated insurance rates in machine-readable format and online.

CMS Administrator Seema Verma said Friday that the government now wants to make insurers disclose their contracted prices as well. She says the revised plan that includes both hospitals and insurers will be rolled out by the end of the year.

Lawsuits that question the the government’s authority to compel private companies to disclose competitive trade secrets are inevitable.

Hospitals would be fined $300 per day for failing to comply with the disclosure requirement, which would cost a multi-billion dollar health system just $109,500 per year to keep its prices secret.

Verma also credits President Trump for lowering health insurance premium prices on Healthcare.gov via his Executive Orders as open enrollment begins.


Reader Comments

From Built to Spill: ”Re: patient name on labels. We changed our system to use the patient’s preferred name on wristbands and labels. The impact was positive, but now fewer characters print and the names are being truncated. Name length issues are a challenge, and this is an unexpected adverse outcome of trying to do a positive thing.” Label formatting is more maddening than a layperson would appreciate. You have limited space and the nature of most text fields is that, unless you use a fixed-width font, you can neither predict nor highlight truncation (names with I’s and E’s may not truncate, but those with M’s and W’s might). I’ve pored over reams of test data as formatted onto a Crystal Reports label or report, dragging the text box a tiny bit wider or narrower in shooting for the best outcome with critical drug and lab test names. You could do something to trigger an adjacent ellipsis to warn the user that the name has been shortened or perhaps check length and then override the default label font to a smaller one, but that leaves the problem unsolved. I vaguely remember that I once programmed a label to combine all its fields into a single big text box with programmatically-added spacing and line breaks in trying to squeeze it all in without truncating (since the odds of all data elements being oversized was small), but I seem to recall that the result didn’t line up nicely and clinicians accustomed to glancing at predictably formatted information were justifiably less than ecstatic.

From Dogged Determination: “Re: Ed Marx. Hope it’s not true that he has left Cleveland Clinic.” Ed didn’t respond to my inquiry, but I see that he has updated his LinkedIn over the weekend to indicate that he left the Clinic last month after 2 1/2 years as CIO and is now an independent consultant.

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From Sunny Jim: “Re: our industry. It never fails to not deliver! I took this in a health system-sponsored, grocery store-based convenient clinic during daytime hours. I told the receptionist it was down, but she just shrugged her shoulders like it happens all the time. We just can’t get away from the clipboard!” I’m amused that the kiosk’s splash screen helpfully explains that it is “Epic’s Self Service Check In Kiosk” and then someone has helpfully taped on a torn scrap of printed paper in an act of customization that announces “KIOSK.” This self-aware message reminds me of no-hunting signs that needlessly say “POSTED” or the legendary title and theme song of the late-1980s Showtime series “It’s Garry Shandling’s Show,” where the song’s opening lyrics were, “This is the theme to Garry’s show.”


HIStalk Announcements and Requests

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About two-thirds of poll respondents who attended HIMSS19 will be at HIMSS20, while a few folks who didn’t go last year will be in Orlando in March. HIMSS is trying to invoke the bandwagon effect of touting increased C-suite and physician registration compared to HIMSS19, but A-Rod’s keynote aside, I would still put my money on a modest attendance decline.

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New poll to your right or here, since people always say the biggest benefit of the HIMSS conference is the networking opportunities: how much of your conference networking benefits your employer versus you personally? Is it more than just socializing, catching up with old friends, having fun, and connecting for a possible job change?

Speaking of HIMSS, I still have a twinge of both regret and relief that I didn’t buy a tiny booth this year so Lorre could say hi to readers in the one time each year she sees them in person, but it involved a lot of money for minimal ROI.  The map of available booths suggests that 250 of the available 449 10×10 booths (the size I bought in previous years) are unassigned. The exhibit hall floor plan shows 1,126 booths taken, about two-thirds of the number available. It also shows just over 100 first-time exhibitors, although the usual churn (along with consolidation) will likely more than offset that number with non-returning HIMSS19 vendors. Total booth square footage leaders, at least by eyeballing, are Epic (12,064), Allscripts (10,800), IBM (10,110), and Cerner (9,074). HIMSS charges a base rate of $39 per square foot, which puts Epic’s basic rent for the three days at $500K, which must be a fraction of what the company will spend for freight, signage, travel and salary costs, and various forms of conference advertising and sponsorship.

I had some big site upgrades performed over the weekend, just in case you noticed something weird (and if you’re still seeing it, let me know since maybe I missed something, although I still have a couple of punch list items). I moved to PHP 7 (specifically 7.3), a faster and more secure version of the server-side scripting language that has been around since 2015. Newer versions are used by only a small percentage of sites since they breaks a lot of old code that someone has to analyze and fix, which to which I can personally attest. 

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Welcome to new HIStalk Platinum Sponsor Bright.md. The Portland, OR-based, physician-founded company offers SmartExam, an AI-powered, asynchronous virtual care platform that increases provider capacity by a factor of 10 and reduces care costs by up to 90%. Patients with hundreds of conditions can be treated in under two minutes and in just three clicks without the provider touching the EHR. The patient interface doesn’t require appointments, video visits, or a broadband connection. SmartExam serves as the virtual front door for health systems, the first step in a ladder of care that moves the patient along their care journey for more complex issues. It can be brought live in 10 weeks or less, delivering a quick win for physician satisfaction and patient delight. The company just delivered significant improvements that include care escalation to a 911 call when triggered by patient question responses, AI-powered interpretation of patient responses to eliminate dropdowns, configurable formularies, and an all-inclusive design approach that is also ADA compliant and does not require patients to choose a gender. Thanks to Bright.md for supporting HIStalk.

Listening: new from Tacocat, Seattle-based punkish, smart-assy pop rockers (whose name is a palindrome, I just noticed) who sound like high school best girlfriends who decided to form a band. Pitchfork summarized an earlier album as, “It feels like taking a joyride with four bonafide party experts egging you on as you drunk-text an ex.” On a more somber side is “Ghosteen,” a new double release from the always-poetic Nick Cave & the Bad Seeds, Cave’s first album written after the 2015 death of his 15-year old son. Nick Cave is a genius and master of art forms that include performing, writing, film scoring, acting, and screenwriting and the Bad Seeds are underrated in being more than just backing musicians. Their live performances are intense, although unfortunately next year’s tour contains no US dates so far.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Google will acquire Fitbit for $2.1 billion in cash, saying it will bring together the best hardware, software, and AI to build wearables. CNBC notes that Google’s hardware aspirations have mostly failed with Nest, Google Glass, its light-selling Pixel smartphone, and its purchase of IP from smart watch maker Fossil having failed to make much of a dent. Its acquisition of Motorola lasted just three years as it sold the company to Lenovo for less than 25% of the price it paid. Fitbit sales were in big trouble, so perhaps the company was right to recast itself as a healthcare and data collection company in catching Google’s eye in what started as a collaboration in April 2018. Let’s see if Google takes a Facebook-like route in linking up wearables data to the wealth of information it holds, using it for purposes we as users might not like, at least those of us who aren’t in Europe where GDPR offers at least some consumer privacy protection. 

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Cleveland’s Global Center for Health Innovation loses its biggest tenant, BioEnterprise, which was also promoting the taxpayer-funded facility that had previously parted ways with its then-largest tenant HIMSS. The developer is trying to figure out how to use the building, with one option being to convert it to meeting space to expand the attached Huntington Convention Center. Taxpayers paid $465 million to build the Center and the convention center.

The Kansas City paper questions whether residents of the declining neighborhoods of south Kansas City are benefiting from the $1.6 billion incentive package that was given to Cerner to build a $4.3 billion campus there on the site of an abandoned mall. They complain that even though 3,000 Cerner employees work on the campus, the only other new development is a single gas station and most employees go straight from the Interstate to the gated Cerner campus and then leave the area after work. The school district loses $2.7 million in annual revenue because of the tax breaks. Local politicians and Cerner had predicted a rejuvenation of the area through new development, but the Walmart remains closed and a neighborhood survey found that the only retail need being met is liquor stores.


People

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Cerner announces in SEC filings the departure of COO Mike Nill and Chief Strategy Officer Joanne Burns in the first quarter of next year. That leaves four executives who were on board when Neal Patterson died in July 2017 – Chief Client Officer John Peterzalek, CFO Marc Naughton, EVP Jeff Townsend, and EVP Donald Trigg. I also noticed that John Glaser has been removed from the executive page even though his individual page as SVP of population health remains, while his LinkedIn shows him as executive senior advisor.

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Denis Zerr (Catholic Health Initiatives) joins Radiology Partners as CIO.


Announcements and Implementations

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The local paper covers the go-live of Kern Medical (CA) on its $30 million Cerner system, showing pride that the hospital, “which had a well-documented history of financial dysfunction,” now has a modern system that is on par with those of competing local hospitals of Dignity Health and Adventist Health.


Government and Politics

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The administrator of Guam Memorial Hospital tells legislators that support for its Optimum system (formerly Keane, then NTT Data, now Cantata Health) will end December 31 but it doesn’t have the money to even start the search for a replacement that could cost $50 million.

CMS is working on Healthcare.gov errors that users experienced on Friday’s first day of open enrollment.


Privacy and Security

The Brooklyn Hospital (NY) says it discovered ransomware in its systems in July 2019 and found that in September 2019 some of its patient data cannot be recovered. Among the lost information is patient name (!!) and cardiac and dental images. The hospital says that recovery efforts are continuing.


Other

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A Newsweek opinion piece by “House of God” author Samuel Shem (aka psychiatrist Joseph Bergman, MD, DPhil) says that “the EMR is essentially a cash register” that was “developed by technocrats as part of the mandate of the Obama administration in 2008” (which is obviously way wrong, but let’s call it creative license). Shem describes a war being waged on both sides of the screen – the hospital’s billing team trying to maximize payment while the insurer’s team tries to minimize it. Shem thinks EHRs should be redesigned to ignore billing requirements like the VA’s VistA (again, good idea, but apropos only in a fictional world, and the VA is dumping VistA for one of those cash registers besides). He closes strong: when someone falls in a theater, does anyone call, “Is there an insurance executive in the house?” Meanwhile, I’ve pre-ordered Shem’s latest book, a “House of God” follow-up that comes out November 12 titled “Man’s 4th Best Hospital.”

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A New York Times essay by UCSF internist, assistant professor, author, and podcaster Emily Silverman, MD says the hospital’s new Epic system amplifies the insecurities of its physician users. She notes:

  • Her first Epic log-in presented a warning that she had “deficiencies,” which she says made her feel like a middle school student whose name was called out in assembly. In contrast, her friends who work at Facebook says the company talks a lot about “voice” in trying to make users feel cared for, with birthday reminders and display of photo memories.
  • Epic has “unintelligible medical notes, filled with ragged vines of superfluous, robot-generated text” and interruptive, mid-documentation demands to choose a patient’s diagnosis from a drop-down list while she is trying to figure out what’s happening with the patient.
  • Entering the chart of a deceased patient, which is often when the physician finds out their patient has died, provides an empathy-free “Deceased Patient Warning” pop-up.
  • She concludes, “A more humane version of Epic would take a different tone. In the absence of a true emergency, its colors and symbols would be neutral, even tranquil. Deceased-patient warnings would recognize the emotional impact of a life lost. Deficiencies and delinquencies would become incomplete tasks, and pop-ups would float into view as small islands of empathy, like the system’s periodic emails. (“Thank you for all of your hard work.”) But until then, the voice of the program itself — urgent, intimidating, and tinged with allegation — will continue to contribute to the profession’s growing sense of despair.”

Cerner SVP John Gresham says the company’s integration with Uber for patient transportation is just one way that Cerner will address social determinants of health, which could include new services such as appointment and prescription reminders that include transportation options, alternatives to ambulance transport that goes beyond Uber’s capability, and prescription delivery.

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Boston Children’s Hospital celebrates the 25th anniversary of its Computational Health Informatics Program (CHIP), which in addition to providing education, created the first personal health record, developed the SMART interoperability protocol, developed HealthMap for visualizing global disease outbreaks, demonstrated the power of analytics and genomics, and spun out several startups. A September 26 symposium reviewed CHIP’s history, then offered panel discussions on what healthcare will look like 25 years from now, including the role hospitals will serve, who will make clinical decisions, how therapies will be developed, and what R&D should be performed now to prepare for the future.

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UCSF hospitalists say moral distress is a root cause of physician burnout and that hospitals should prioritize ethics and the “inherently unethical” healthcare system should be reformed to prioritize patients over shareholder profits. They also urge education in ethics and for doctors to be encourage to advocate for issues that affect their patients, such as gun control and universal health coverage. They cite these specific problems:

  • Pressure to reduce costs in some areas while increasing them in others through profitable prescribing or referrals.
  • Being forced to provide futile or harmful treatments because the patient hasn’t completed an advance directive or family members can’t agree on end-of-life care.
  • Trying to deliver consistently good care despite economic disparities caused by high costs, high insurance deductibles, and a “gutted social safety net.”

Sponsor Updates

  • Health Catalyst and Nordic will exhibit at the CHIME19 Fall CIO Forum November 3-6 in Phoenix.
  • Mobile Heartbeat will host MHUG 2019 November 6-8 in Phoenix.
  • Waystar will exhibit at the Health Management Academy CFO Forum November 6-10 in Laguna Beach, FL.
  • Netsmart will exhibit at the MHCA Fall Conference November 5-7 in Atlanta.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS South Carolina Annual Fall Conference November 1 in Columbia.
  • Experian Health and StayWell will exhibit at the Healthcare Internet Conference November 4-6 in Orlando.
  • PerfectServe will exhibit at the Society of Hospital Medicine Leadership Academy November 4-7 in Nashville.
  • Surescripts will exhibit at the PointClickCare Summit November 3-6 in Dallas.
  • Vocera will exhibit at the Florida Organization of Nurse Executives Fall Conference November 7-8 in Orlando.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Weekender 11/1/19

November 1, 2019 Weekender 3 Comments

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Weekly News Recap

  • UnitedHealth’s Optum acquires remote patient monitoring startup Vivify Health.
  • Waiting room advertising company Outcome Health pays $70 million in customer restitution to settle Department of Justice advertising fraud charges.
  • Australia’s Queensland Health confirms media reports that it ordered its IT department to perform no software upgrades, including to its problematic Cerner system, while parliament is in session to avoid embarrassment.
  • Premier acquires purchased services management technology vendor Medpricer.
  • Medecision acquires GSI Health.
  • ESolutions acquires Medidal.
  • Facebook launches a program in which user demographics will trigger preventive health information and reminders.
  • Google parent Alphabet is rumored to have made an offer to acquire Fitbit (the companies announced Friday that the acquisition is set for $2.1 billion).  
  • Cerner says in its earnings call that it will no longer offer outsourced revenue cycle management services after Adventist Health terminate its contract, which triggered a $60 million charge and an annual revenue reduction of $170 million.

Best Reader Comments

Deleting your Facebook account does not actually stop any tracking. All your web activity is still tracked via pixels and linked back to your deactivated FB account (example: I still would know you are a 40 year old woman with two kids over 8 who lives in a specific zip code and has certain interests from your old FB activity). I can still target ads to you through websites who publish ads through Facebook, “audience network.” (FB Marketer)

How can the responses of 6-7 customers out of thousands [in KLAS’s global VNA report] be classed as “global” insight and customer feedback? (PluckyBrit)

Why so cynical re: HLTH? I’m here now, and am finding it refreshingly relevant compared to HIMSS or Beckers. For goodness sake, the keynote presentations actually focused on current issues, and didn’t just include big name politicians, sports stars, or actors. Sure, there’s glitz, and the caricatures, etc., but for conferences, I’ve found it to have more of a “finger on the pulse of what’s coming” than any other major conference out there. (CynicAl)

Banner Health bought the University of Arizona’s medical arm and transitioned them from Epic to Cerner. It’s the reason Epic had to change their spiel to “no *voluntary* deinstalls.” (Math)

I don’t think [EHR training driving provider satisfaction and adoption] has been a big secret to those who have gone through the implementation cycle multiple times, yet it’s always the first thing in the budget to get cut. You’d think that the vendors would be more prescriptive (as opposed to “advisory”) when detailing training requirements during planning. Or maybe it’s a failure of CIOs to make the case to CMOs, CFOs and CEOs that they’re being penny wise and pound foolish. Maybe this KLAS survey will help. (Recovering CIO)


Watercooler Talk Tidbits

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ProPublica profiles 27-year-old Nerds on Call computer technician Michael Gillespie (guess which one is him in the photo above, as he receives an FBI award), who has cracked 100 forms of ransomware and provides free decryption tools that have saved hundreds of millions of dollars worth of avoided ransom payments. He receives 2,000 files per day from panicked computer users asking for help and spends his evenings on his couch surrounded by his cats, decrypting new strains and corresponding with people who are seeking his assistance. There’s a healthcare connection – he and his wife are broke because of the after-insurance costs of treating her newly discovered bladder cancer, which forced him to take a 2 a.m. paper route, surrender their car to the bank, and overcome threats of foreclosure of their $116,000 house in Normal, Illinois. Pestered by relatives who can’t understand why he helps people for free, Gillespie says, “There’s a time in every IT person’s career where they think, I’m on the wrong side. You start seeing the dollar amounts that are involved. But nah, I can’t say that I ever have. I just don’t care to go that way.”

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The offshore folk who announce a $3,000 market research report and then write it only after someone pays must know, as experts,  something we don’t – that Athenahealth, Allscripts, Epic and clinical trials platform vendor Medidata are among the sellers of pharmacy robotic dispensing systems. They say it’s a big market that is being energized because “the case of non-infectious diseases also increases.” You could take advantage of the company’s offer to “kindly feel free to grill us with queries” as it has “established the pillars of our flourishing institute on the grounds of Credibility and Reliability.”

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A despondent woman whose friend called 911 fearing for her safety is billed $30,000 by Northwestern Medicine Central DuPage Hospital for a five-night psych stay. She had bought one of the White House-touted “association health plans” (aka ACA-non-compliant junk insurance) that costs less but covers little. She knew her $210 per month plan didn’t cover mental health services, but said she didn’t expect to need them. She asked the hospital what each treatment was going to cost her, but they couldn’t answer, leaving her with a bill for double the average negotiated price (since cash-paying patients are billed higher than everybody else in our non-system). The hospital wrote the bill down to $9,000 and adds that they offered the patient help, but she didn’t return their calls or fill out their financial aid forms. She also admits that she started to buy real insurance through Healthcare.gov, but thought the information was confusing. I’m siding with the hospital on this one (although not the idea of insurer-negotiated pricing) since she blew several opportunities to make a responsible decision. But then again, much of our population seems incapable of making responsible decisions, sticking the rest of us with the bill.  

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A Texas woman live-streams her brain surgery on Facebook in hopes of encouraging others to be optimistic about their outcomes. The stream skipped the graphic parts and instead featuring her speaking to the surgery team while remaining awake as the chief of neurosurgery of  Methodist Dallas Medical Center narrated and answered viewer questions. She went home two days later.

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Police arrest a Louisiana medical practice clerk for selling fake doctor’s notes to high school students for $20, of which two students bought 14. 

The New York Times suggests that patients avoid seeing doctors whose practices are owned by hospitals, whose facility fees can tack on unexpected hundreds to thousands of dollars per visit.

This has Weird News Andy written all over it. Entrepreneur David Hachuel, MSc, MPH, who hopes to commercialize an AI-powered stool analyzer, seeks 100,000 photos of bowel movements for training the system. Experts say a poop tracking app is sort of a good idea, but worry that it will send tons of healthy people to doctors unnecessarily and that a better approach would be to actually analyze a sample only when medically indicated. I read this and ponder, has any doctor ever actually asked a patient to bring in a photo of their bowel movement, and if not, how does an app add value? And also, are we so short on good uses of IT in health that poop photo analysis will lure investors? (cue Sally Field in the 1965 “Gidget” episode titled “All the Best Diseases are Taken,” which I just found by Googling in thinking instead of an “Arrested Development” reference). I would swear that Auggi’s video (above) and its rather foul call for photos were actually clever spoofs from The Onion.


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Morning Headlines 11/1/19

October 31, 2019 Headlines 1 Comment

UnitedHealth, an insurance giant, just scooped up patient monitoring start-up Vivify Health

Optum acquires remote patient monitoring startup Vivify Health.

Exclusive: ‘Inappropriate’ email reveals Queensland Health’s ploy to avoid political scrutiny of hospital IT outages

Australian media outlets report that senior Queensland Health officials ordered staff at the region’s hospitals to avoid performing upgrades to digital systems – including Cerner’s problematic IEMR software – while parliament is in session so as to avoid embarrassing scrutiny from politicians.

Audacious Inquiry and The Sequoia Project Announce National Collaboration to Support States in Disaster Response Through the Patient Unified Lookup System for Emergencies (PULSE)

Audacious Inquiry will work with The Sequoia Project to expand availability of the Patient Unified Lookup System for Emergencies (PULSE) during disaster response efforts.

WMH announces 35 layoffs, reduction of services

Williamson Memorial Hospital in rural West Virginia attributes layoffs and the closure of several clinics to extreme delays in collections and an absence of cash flow stemming from its Meditech implementation several months ago.

News 11/1/19

October 31, 2019 News 1 Comment

Top News

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Point-of-care patient education and marketing company Outcome Health avoids prosecution by the DoJ for the fraudulent acts of former executives by agreeing to pay $70 million in restitution to customers and to continue with its remediation efforts.

The Chicago-based company was once valued at $5 billion. Its founders came under fire in 2017 for overcharging drug company advertisers by intentionally inflating the number of waiting room screens running their ads, manipulating third-party ad performance analyses, and creating phony ad campaign screen shots.


Reader Comments

From Rolling it Back: “Re: Walmart Health. Any idea what they are using for an EHR in their new clinic?” I posed that question to Walmart’s PR team, but haven’t heard back so far. Jenn did a a couple of visits to the clinic since the pilot site is in her home town. They told her they’re using Athenahealth, Orchard for labs, and a third system whose name the tech couldn’t recall. They’re also using Zotec for patient self-scheduling. You can read her first-person experience as a patient here.

From Barred Roller: “Re: surveys. Have you done a survey of hospital C-suite leadership about how they use KLAS in making decisions?” I’ve done various KLAS-related poll questions, but respondents are anonymous and thus not limited to verified hospital executives. My experience is that health systems use KLAS more for vendors outside the inpatient EHR realm, since for those, most hospitals will have just two logical choices (not always Epic and Cerner, I should add) and can pick one without help, using factors that go beyond simple user scores. It’s also good to sneak a peek before naming your frontrunner since your executive peers and board members may do that (at the urging of one of the companies that is in the hunt, sometimes) and you need to be ready to explain why you’re buying the #3 product. Lastly you read the comments to make sure you aren’t surprised by a subtle trend, a user-reported issue that hits home, or any good or bad results that were caused by switching to or from your chosen product. All that aside, a health system that is competent and earnest should be able to make their own decision based on references, site visits, and the vendor’s willingness to pay penalties for failing to deliver. That last item is a big one – while health systems sometimes choose a product unwisely, more aggressive contract T&C instead of just signing lawyer-approved boilerplate would flush out a pretender vendor who knows their own weaknesses, but hopes you don’t. List your biggest fears and account for them with required penalties.

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From Stock Picker: “Re: health IT stocks. I don’t understand why people buy shares of second-rate product and service vendors. Can’t they read financial reports?” While share price will eventually reflect company performance — even as shifty executives try to keep the shell moving with slick financial transactions and market-confusing acquisitions – a share of stock is ultimately worth exactly what someone else will pay you to take it. Shareowners don’t necessarily have any more confidence in the long-term performance of a company than skeptics, but rather hope that company news, irrational stock market exuberance, or the possibility of an acquisition will reward their patience. TL; DR: share price is a reflection of many factors, of which hard performance numbers play a minor role (until they don’t).


HIStalk Announcements and Requests

The folks at Definitive Healthcare confirmed a reader’s question about the Meditech replacement at Christus Good Shepherd Medical Center – Longview (TX) as I mentioned Monday. Definitive rechecked and they are indeed  moving to Epic, not Cerner. Thanks for the correction.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Meditech reports Q1 results: revenue up 2%, EPS $2.44 vs. $0.52, although the net income increase was due to selling a building for $120 million that booked a gain of $89 million. Product and service revenue both increased slightly

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Huron joins virtual hospital company Medically Home Group’s Series B round of funding and becomes the exclusive implementation partner for its hospital-to-home care services.

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Optum acquires remote patient monitoring startup Vivify Health. Founder and CEO Eric Rock also founded EDIS vendor Medhost.

Falconer Pharmacy in New York files a class-action lawsuit against Surescripts, alleging that the company has forced the pharmacy to use its e-prescribing network to avoid higher transaction rates as a “non-loyal customer.” The suit names Allscripts and RelayHealth as co-conspirators.

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Group purchasing organization and consulting firm Premier Inc. acquires Medpricer, a developer of purchased services management technology, for $35 million.


Sales

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  • In England, Alder Hey Children’s Hospital in Liverpool will implement Meditech Expanse.

People

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Cardiologist David Tsay, MD (Columbia University Medical Center) joins Apple’s health team.


Announcements and Implementations

Audacious Inquiry will work with The Sequoia Project to expand availability of the Patient Unified Lookup System for Emergencies (PULSE) during disaster response efforts. The system was initially used by the California Emergency Management Services Authority during wildfires in 2017.

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Livongo adds telemedicine services from MDLive and Doctor on Demand to its digital solutions for patients suffering from chronic conditions.

Geisinger (PA) implements Life Image’s Mammosphere software, giving women the ability to request, store, and share breast health records through its system-wide KeyHIE.

USF Health Morsani College of Medicine (MCOM) at the University of South Florida will partner with Microsoft to create a Medical School of Innovation in the school’s new building that will open soon. Microsoft will provide Teams, Power BI, curriculum-monitoring analytics, and Surface Studios and Hubs. 


Government and Politics

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Finger-pointing ensues after Australian media outlets report that senior Queensland Health officials emailed staff at the region’s hospitals ordering them to avoid performing upgrades to digital systems – including Cerner’s problematic IEMR software – while parliament is in session so as to avoid embarrassing scrutiny from politicians. A Queensland Health representative has since labeled the email inappropriate, adding that planned upgrades will take place with at least a week’s notice and at times that are least inconvenient to patient care.

Beckman Coulter Diagnostics will use a $2.5 million grant from HHS to develop and commercialize a sepsis-detection algorithm for hospitals.


Other

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Popular Science profiles the progress Facebook and the NYU School of Medicine’s Department of Radiology are making with their FastMRI project. Announced a little over a year ago, the knee-focused project aims to develop AI that can generate MRI scans up to 10 times faster than traditional methods. Researchers are preparing to submit their study for academic review. Once submitted, they’ll then study whether AI-created images match what surgeons see when they perform knee surgeries.

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Wolters Kluwer will use a $1 million grant from Ancestry to develop ways providers can interpret and act on the results of genetic testing using its UpToDate evidence-based clinical resource. Ancestry began offering genetic testing alongside its family heritage services earlier this month.

Astria Health (WA) lays off staff and implements a shared services agreement in hopes of emerging from the Chapter 11 bankruptcy it filed in May 2019. It said an unnamed vendor was unable to collect $75 million in patient revenue. The health system implemented Cerner in mid-2018. Its new revenue cycle outsourcer is Gaffey Healthcare.

Medical residents and fellows at Yale New Haven Hospital crash a graduate medical education committee meeting to unfurl a banner reading “Doctors are Humans Too” and to present a Bill of Rights in which they demand working conditions that are safe for patients, elimination of workplace discrimination, adequate supervision, fair evaluations, treating patients the same regardless of their ability to pay, comprehensive health insurance with mental health coverage, and being paid a living wage.

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Wags speculate that the suddenly widespread shortage of black turtlenecks in San Francisco is being caused by their repurposing for Halloween costumes by people who are dressing up as disgraced Theranos CEO Elizabeth Holmes.

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Weird News Andy says this patient can no longer count to 24, but will save on pedicures. Surgeons in China remove the four extra toes on a 21-year-old man’s left foot. He had stopped wearing sandals and has never had a girlfriend because of his insecurity, but his parents had refused to let him have the surgery because the extra digits were a “gift from the heavens” that could always be covered up with shoes (unless they are Vibrams).


Sponsor Updates

  • EClinicalWorks will exhibit at APHA 2019 November 3-5 in Philadelphia.
  • Ellkay and InterSystems will exhibit at the CHIME CIO Fall Forum November 3-6 in Phoenix.
  • Ensocare will exhibit at the ACMA Greater Houston Chapter Annual Conference November 2 in Houston.
  • TriNetX will report its findings about using EHR data for research at ISPOR Europe 2019 November 2-6 in Copenhagen, Denmark.
  • Healthwise and Kyruus will exhibit at the Healthcare Internet Conference November 4-6 in Orlando.
  • Meditech publishes a new case study, “Summit Pacific Increases Reimbursement, Clinic Volumes with Meditech Analytics.”
  • The Chartis Group names Roger Ray, MD (Atrium Health) physician consulting director.
  • Black Book names Nuance the top vendor for end-to-end coding, CDI, transcription, and speech recognition technologies for the seventh consecutive year.
  • Prepared Health CEO Ashish Shah will speak on a panel at the PointClickCare Summit: “Using Data to Build a Bridge to Better Care,” November 5 at 1:45 in Dallas.
  • Google Cloud adds digital clinical assistant startup Suki to its Partner Advantage Program.

Blog Posts


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